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Case Reports
. 2025 Jul 7;17(7):e87441.
doi: 10.7759/cureus.87441. eCollection 2025 Jul.

Primary Cutaneous Epstein-Barr Virus (EBV)-Positive Diffuse Large B-cell Lymphoma With Synchronous Systemic T-cell Lymphoma: A Case Report

João Soares  1 , João Teixeira  1 , Carolina Afonso  2 , Joana Calvão  1 , Maria Manuel Xavier Brites  1 , Jose C Cardoso  1
Affiliations
Case Reports

Primary Cutaneous Epstein-Barr Virus (EBV)-Positive Diffuse Large B-cell Lymphoma With Synchronous Systemic T-cell Lymphoma: A Case Report

João Soares et al. Cureus. .

Abstract

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare and aggressive lymphoma that has been associated with age-related immunosenescence. Here, we present the case of a 79-year-old man with violaceous nodules on the skin, mainly on the lower and upper limbs, diagnosed as primary cutaneous EBV-positive diffuse large B-cell lymphoma (DLBCL) based on histopathological and immunohistochemical findings. Systemic evaluation revealed synchronous peripheral T-cell lymphoma, not otherwise specified (NOS), without systemic B-cell lymphoma involvement. The patient was treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine (Oncovin), and prednisone (R-CHOP) chemotherapy, achieving a complete response for both lymphomas, with sustained outcomes after one year of follow-up. This case highlights the importance of age as a risk factor for EBV-related malignancies, the role of Epstein-Barr encoding region (EBER) and cluster of differentiation 30 (CD30) testing in diagnosis, and the potential effectiveness of R-CHOP in treating this rare lymphoma association. Further research is needed to establish optimal management strategies.

Keywords: case report; diffuse large b-cell lymphoma; ebv; r-chop; t-cell lymphoma.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Violaceous nodules on the lower limbs (A), on the right forearm (B), and on the left leg (C) of the patient.
Figure 2
Figure 2. Histopathological and immunohistochemical features of a violaceous nodule suggestive of EBV-positive diffuse large B-cell lymphoma (DLBCL).
(A) Low-magnification histology showing a dense non-epidermotropic infiltrate suggestive of B-cell lymphoma (hematoxylin and eosin {H&E}, ×20). (B) High-magnification histology revealing a predominance of large lymphocytes, including centroblasts (yellow arrow), immunoblasts (green arrow), and other atypical lymphocytes (red arrow) (hematoxylin and eosin, ×200). (C-F) Immunohistochemical staining demonstrating positivity for MUM1, CD79a, EBV (EBER by in situ hybridization), and CD30, characteristic of EBV-positive DLBCL. MUM1, multiple myeloma oncogene-1; EBV, Epstein-Barr virus; CD, cluster of differentiation; EBER, Epstein-Barr encoding region
Figure 3
Figure 3. Baseline and 12‑month follow‑up FDG-PET-CT demonstrating complete metabolic response.
(A) Whole‑body PET-CT scan at diagnosis reveals widespread hypermetabolic lymphadenopathy. (B) Axial PET-CT at the cervical level shows a left lateral cervical node (straight white arrow). (C) Coronal PET-CT below the diaphragm depicts multiple infra‑diaphragmatic adenopathies (straight white arrows). (D-F) Corresponding views obtained 12 months after six cycles of R‑CHOP: whole‑body (D), cervical (E), and infra‑diaphragmatic (F) images demonstrate complete metabolic response. FDG, fluorodeoxyglucose; R-CHOP, rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine (Oncovin), and prednisone
Figure 4
Figure 4. Follow-up, three months post treatment, with total resolution of the skin nodules.
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